Provider Demographics
NPI:1346363264
Name:TROY WILLIAM FRIESEN
Entity Type:Organization
Organization Name:TROY WILLIAM FRIESEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:W
Authorized Official - Last Name:FRIESEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:763-494-4900
Mailing Address - Street 1:4632 85TH AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-1957
Mailing Address - Country:US
Mailing Address - Phone:763-494-4900
Mailing Address - Fax:763-494-4902
Practice Address - Street 1:4632 85TH AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-1957
Practice Address - Country:US
Practice Address - Phone:763-494-4900
Practice Address - Fax:763-494-4902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-07
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3157261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service